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‘Til Death Do Us Part: End‐of‐Life Experiences of Married Couples in a Nationally Representative Survey
Author(s) -
Kotwal Ashwin A.,
Abdoler Emily,
DiazRamirez L. Grisell,
Kelley Amy S.,
Ornstein Katherine A.,
Boscardin W. John,
Smith Alexander K.
Publication year - 2018
Publication title -
journal of the american geriatrics society
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.992
H-Index - 232
eISSN - 1532-5415
pISSN - 0002-8614
DOI - 10.1111/jgs.15573
Subject(s) - spouse , medicine , demography , odds ratio , socioeconomic status , logistic regression , confidence interval , marital status , gerontology , health and retirement study , odds , population , environmental health , sociology , anthropology
Objectives To determine whether end‐of‐life (EOL) experiences in the first spouse in a marriage are associated with EOL experiences in the other spouse. Design Nationally representative, longitudinal survey. Setting Health and Retirement Study, Waves 1992–2012 linked to Medicare claims Participants Community‐dwelling older adults who died (N=4,558), representing 2,279 married heterosexual couples. Measurements We examined 3 EOL experiences: enrollment in hospice for >3 days before death, lack of advance care planning (ACP) before death, and intensive care unit (ICU) use during the last 30 days of life. We used multiple logistic regression to determine whether the EOL experience of the first spouse was a significant predictor of the EOL experience of the second spouse after adjusting for demographic characteristics, socioeconomic status, health status, and time between the first and second spouses' deaths. Results First spouses who died were on average 80 years old, and 62% were male; second spouses were on average 85 years old, and 62% were female. After adjustment, second spouses were more likely to use hospice if the first spouse used hospice (odds ratio (OR)=1.68, 95% confidence interval (CI)=1.29–2.20). Second spouses were less likely to have ACP when the first spouse did not have ACP (OR=2.91, 95% CI=2.02–4.21). Hospice and ACP associations were stronger when deaths were closer in time to one another (p‐value for interaction < .05). Second spouses were more likely to use ICU services if the first spouse did (OR=1.80, 95% CI=1.27–2.55). Conclusions The EOL experiences of older spouses are strongly associated, which may be relevant when framing ACP discussions. J Am Geriatr Soc 66:2360–2366, 2018